Leaving aside, for the purposes of this discussion, the inefficiency of the NHS in the UK, my biggest objection to socialised medicine is that the authorities feel entitled to prescribe lifestyle choices. We see it with the 21 units of alcohol nonsense and the 5 a day nonsense, not to mention smoking.

Other readers may be more familiar than me with the idea that ‘the difference between a welfare state and totalitarianism is a matter of time.’ I don’t know who said that.
Individual accounts would avoid being subject to state diktats.
Savings yes, for conditions that are inevitable or almost inevitable. I take that point.
Insurance for bad luck.

Would that work?

Laird, where do you want to get to, and what is your route?

]]>By: Richard Thomashttps://www.samizdata.net/2012/03/the-liberty-lea/#comment-231142
Mon, 05 Mar 2012 15:34:32 +0000http://192.168.200.139/?p=14779#comment-231142The problem with health savings accounts, as implemented was that you had to estimate how much healthcare you would use in the coming year at the beginning of the year. If you needed more, you’d have to spend out-of-pocket. If you didn’t need it all, the remaining money “went away” at the end of the year(I never did get to the bottom of that). That made it something of a peculiar gamble. Not that they couldn’t be implemented sanely, of course, but that’s just an example of the kind of scheme government comes up with.

In my opinion, one of the most sensible health-insurance reforms would have been to make health insurance less tied to employment. We have lost important employment mobility with people too scared to change jobs because they lose healthcare. Another would be to remove certain restrictions in play that make it hard for companies to compete across state lines.

]]>By: Johnathan Pearcehttps://www.samizdata.net/2012/03/the-liberty-lea/#comment-231141
Mon, 05 Mar 2012 15:05:21 +0000http://192.168.200.139/?p=14779#comment-231141James, I disagree. Compulsory health insurance is, as I am sure Laird would agree, turning out to be a big mistake in the US, for example, as seen by Mitt Romney’s undistinguished tenure in Mass. and now with Obama’s health programme.

The problem with insurance is that it is not in fact a great model for paying for healthcare. We insure against relatively random, non-common risks such as theft and fire. With health, on the other hand, you can more or less predict that spending on health tends to map with age. As you get older, then – other things being equal – your spending on healthcare tends to rise, especially beyond middle age.

As reforms go, a much smarter move, in my opinion, is to encourage personal health savings accounts. To get them started, you could put these on a tax-advantaged basis, such as a mutual fund plan that many people have. They would be controlled by the individual, but tax benefits would only operate if the money was devoted to health. If, upon death, there was money left in the pot, this would fall into the deceased’s estate like any other asset.

Insurance is fine for catastrophic and hopefully rare events, and should not be dismissed completely. But in the main it is not in my view the right way to pay for healthcare.

]]>By: Lairdhttps://www.samizdata.net/2012/03/the-liberty-lea/#comment-231140
Mon, 05 Mar 2012 14:11:42 +0000http://192.168.200.139/?p=14779#comment-231140James, that depends entirely upon “where we’d like to be.” I suspect that where you’d like to be and where I’d like to be are quite different places.
]]>By: James Stronghttps://www.samizdata.net/2012/03/the-liberty-lea/#comment-231139
Mon, 05 Mar 2012 12:27:53 +0000http://192.168.200.139/?p=14779#comment-231139Compulsory health insurance.
OK, I know I’m neither well-read in the theory nor an ideologically pure libertarian but it seems to me that this is the best achievable way of breaking socialised medicine and getting towards freedom of choice for medical provision.
Of course nobody likes the idea of compulsion but if we had compusory health insurance similar to the way we have compulsorty Employer’s Liability Insurance and compulsory Third Party motor insurance wouldn’t that be the best step that could be taken to get from where we are to where we’d like to be?
]]>By: Alisahttps://www.samizdata.net/2012/03/the-liberty-lea/#comment-231138
Mon, 05 Mar 2012 10:43:08 +0000http://192.168.200.139/?p=14779#comment-231138RRS: but does it really have to be an “either/or”, or is this how the two sides (Kochs vs everyone else) are indeed seeing it?
]]>By: RRShttps://www.samizdata.net/2012/03/the-liberty-lea/#comment-231137
Mon, 05 Mar 2012 03:35:45 +0000http://192.168.200.139/?p=14779#comment-231137It seems today that few people are aware of the “forces” that brought about the formation (and funding) of Think Tanks in the U S, in response to, and as a shield against, the dominance of the chains of socialist, collectivists, diregists in academia, which were shaping public policy with almost no other qualified viewpoints available.

For years, I was a “Sponsor” at Cato; not of the Koch classification, of course, all back before the expansion of Cato’s fields of policy concerns, and the move to Mass Ave, but continued for some time after. I had shifted from American Heritage when two squirrels there (from the U K as I recall) came out with a plan for compulsory health insurance – goodbye to Ed Fuelner, hello Ed Crane.

To shift the function of this Think Tank (Cato) to “political targeting” will be to lose a principal offset (and function of principle) to the still deficient conditions at our universities, and their self-perpetuating faculties and staffs.

However, if that happens, another enterprise will rise in its place, peopled by Cato alums.

I hope The troops at Koch (I don’t think it is Charles) will proceed with caution.

]]>By: 'Nuke' Grayhttps://www.samizdata.net/2012/03/the-liberty-lea/#comment-231136
Sun, 04 Mar 2012 23:43:19 +0000http://192.168.200.139/?p=14779#comment-231136Whilst April Fool’s Day (1st of April) now has negative connotations, I think we can rehabilitate it, so that it celebrates the rights of nonconformists! Let April Fool’s Day also be known as Eccentric’s Day!
So the fact that this conference will end on Eccentric’s Day is a serendipitous occasion!
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